
                        Dialectical Behavioral Therapy
                                       
   Marsha Linehan (1991) pioneered this treatment, based on the idea that
   psychosocial treatment of those with Borderline Personality Disorder
   was as important in controlling the condition as traditional psycho-
   and pharmacotherapy were. Concomitant with this belief was a
   hierarchical structure of treatment goals. Paramount among these was
   reducing parasuicidal (self-injuring) and life-threatening behaviors.
   Next came reducing behaviors that interfered the the therapy/treatment
   process, and finally reducing behaviors that reduced the client's
   quality of life. In 1991, Linehan published results of a study that
   seems to do remarkably well at achieving these goals.
   
The Theory

   Basically, DBT maintains that some people, due to invalidating
   environments during upbringing and due to biological factors as yet
   unknown, react abnormally to emotional stimulation. Their level of
   arousal goes up much more quickly, peaks at a higher level, and takes
   more time to return to baseline. This explains why borderlines are
   known for crisis-strewn lives and extreme emotional lability (emotions
   that shift rapidly). Because of their past invalidation, they don't
   have any methods for coping with these sudden, intense surges of
   emotion. DBT is a method for teaching skills that will help in this
   task.
   
How it works

   Dialectical Behavioral Therapy (DBT) consists of two parts:
    1. Once-weekly psychotherapy sessions in which a particular
       problematic behavior or event from the past week is explored in
       detail, beginning with the chain of events leading up to it, going
       through alternative solutions that might have been used, and
       examining what kept the client from using more adaptive solutions
       to the problem:
       
     Both between and during sessions, the therapist actively teaches
     and reinforces adaptive behaviors, especially as they occur within
     the therapeutic relationship. . . the emphasis is on teaching
     patients how to manage emotional trauma rather than reducing or
     taking them out of crises. . . . Telephone contact with the
     individual therapist between sessions is part of DBT procedures.
     (Linehan, 1991)
       DBT targets behaviors in a descending hierarchy:
          + decreasing high-risk suicidal behaviors
          + decreasing responses or behaviors (by either therapist or
            patient) that interfere with therapy
          + decreasing behaviors that interfere with/reduce quality of
            life
          + decreasing and dealing with post-traumatic stress responses
          + enhancing respect for self
          + acquisition of the behavioral skills taught in group
          + additional goals set by patient
    2. Weekly 2.5-hour group therapy sessions in which interpersonal
       effectiveness, distress tolerance/reality acceptance skills,
       emotion regulation, and mindfulness skills are taught (see
       summaries of sample [1]worksheets). Group therapists are not
       available over the phone between sessions; they refer patients in
       crisis to the individual therapist.
       
  Followup studies
  
   Since the 1991 paper, Linehan has been involved in several replication
   studies and has written a book and a skills training manual about DBT.
   Her results consistently show that DBT does seem to reduce the amount
   of self-injury and crisis among clients. (See [2]references.
   
   Linehan's group works out of the University of Washington in Seattle,
   but there are DBT-trained therapists in other parts of the U.S. For
   information, try contacting the University of Washington Department of
   Psychology or go to [3]DBT Seattle.
   
   There is also a DBT skills discussion list, also at UW. To subscribe,
   send mail to the listowner (Kieu) at [4]busserv@u.washington.edu
   explaining your background and why you'd like to be on the list. It's
   intended to be a place to share experiences and get support while
   using dbt skills.
   
   For a comprehensive, scientific review of DBT, see [5]Dialectical
   Behavioral Therapy by Barry Kiehn and Michaela Swales of Gwynfa
   Adolescent Service in North Wales.
   
   [INLINE]
   
  return to [6]SI main page

References

   1. file://localhost/usr/home/llama/Web/psych/self.html#dbt
   2. file://localhost/usr/home/llama/Web/psych/refs.html#linref
   3. http://dbt-seattle.com/
   4. mailto:busserv@u.washington.edu
   5. http://www.mentalhelp.net/articles/dbt1.htm
   6. file://localhost/usr/home/llama/Web/psych/injury.html
